Forms

If the patient is an adult, go to the “All Adults” section and complete the listed forms, or if the patient is a child or adolescent, complete the forms under “All Children/Adolescents.” Other forms may or may not be applicable; we can discuss that at the first session. If you do not yet have Adobe Acrobat Reader installed on your computer to open PDFs, you can download it for free from Adobe here.

Some of these forms are "fillable" PDFs that can be filled out on your computer. Depending on your browser and email, you may be able to send in completed forms by clicking on the “Submit Form” button at the end of each form. Or, completed forms can be uploaded from your computer at our Contact page or attached to an email sent to Dr. Buchanan at doc4add@mindspring.com. Forms can also be printed and faxed to (678) 624-0258. If you plan to bring completed forms with you to the first session, PLEASE PRINT TWO-SIDED if possible.

All Adults:

Adult Intake Form

npp_adult_intake_form_02222022a.pdf
File Size:	292 kb
File Type:	pdf

Download File

Psychological Services Contract

npp_psychological_services_contract_02222022a.pdf
File Size:	309 kb
File Type:	pdf

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HIPAA

npp_hipaa_02222022a.pdf
File Size:	298 kb
File Type:	pdf

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All Children/Adolescents:

Child/Adolescent Intake Form

npp_child_adolescent_intake_form_02222022a.pdf
File Size:	248 kb
File Type:	pdf

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Psychological Services Contract

npp_psychological_services_contract_02222022a.pdf
File Size:	309 kb
File Type:	pdf

Download File

HIPAA

npp_hipaa_02222022a.pdf
File Size:	298 kb
File Type:	pdf

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If the child or adolescent is here for testing, also complete the following:

Developmental and Medical History

npp_developmental_and_medical_history_02222022a.pdf
File Size:	1093 kb
File Type:	pdf

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Authorization of Release of Information Forms:
A separate Release Form is required for each person or facility sending/receiving information to/from us.
Please be sure to sign each Release Form in two places.

Adult Release Form

npp_adult_release_form_02222022a.pdf
File Size:	655 kb
File Type:	pdf

Download File

Child/Adolescent Release Form

npp_child_adolescent_release_form_02222022a.pdf
File Size:	282 kb
File Type:	pdf

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Informed Consent for Forensic Services:

Custody Evaluation

npp_informed_consent_for_psychological_custody_evaluation_02222022a.pdf
File Size:	272 kb
File Type:	pdf

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Psychological Evaluation During a Legal Dispute

npp_informed_consent_for_psychological_evaluation_during_a_legal_dispute_02222022.pdf
File Size:	502 kb
File Type:	pdf

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Forensic Psychological Evaluation

npp_informed_consent_for_forensic_psychological_evaluation_02222022a.pdf
File Size:	267 kb
File Type:	pdf

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Collateral Agreement

npp_collateral_agreement_02222022a.pdf
File Size:	199 kb
File Type:	pdf

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